HomeMy WebLinkAbout04-0078PETITION FOR PROBATE and GRANT OF LETTERS
Estate of '/~? ":/.~'/LC'- ~, /~'L.//V/<
also known as
No.
To:
, Deceased.
Social Security No.. / ~ ~ · o.f - ~ _f- ~ 9
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the execut o&
in the last will of the above decedent, dated. A ) o V' ~ i ~
and codicil(s) dated - '
Register of Wills for the
County of £UMRFRI AND
Commonwealth of Pennsylvania
in the
named
, 19.9~(
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in _c~ ~ ?, g/'e ~-g4 N t~ County, PerinSylvania, with
last family or principal residence at 3 ~.C ~, £; ~ ~ . - c ~ ~x~ _~ ,~ ,e'
-
(list street, number and muncipality)
Decendent, then. ~/~ ~ve, ars of age, died
at ~'oOc ~.-'ie ~ to IJ t-~ o et ~ , 19 ,
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for not the victim of a killing and was never adjudicated
incompetent: ~ 7-" probate; was
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property $
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania
situated as follows: $
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters.
theron. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
Sworn to or af~r..ql~ and subscribed .- -, "'Z~..~ ~ '7,.~
be~oye me this ~'1" ~ day of / '
OATH OF-PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ~
COUNTY OF CUMBERLAND ss
Thc petitioner(s) above~named swear(s) or affirm(s) that thc statements in the foregoing petition arc
truc and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of thc above decedent petitioner(s) will well and truly administer thc estate according to law.
/
Estate Of MARIE A KLINK ., Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW JANUARY 27, 2004
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated NOV. 14, 1994
described therein be admitted to probate and filed of record as the last will of
MARIE A KLINK
and Letters TESTAMENTARY
,x 10(_ , in consideration of the petition on
are hereby granted to FRA~
FEES
Probate, Letters, Etc .......... $ ~0. ~
Short Certificates( ) ' $~
$ lO.OD
TOTAL s3~b .0o
Filed .. ~ ' .~...-t..~..~.9..~.~ ................
EXECUTOR PICKED UP 1=27=2004
ATTORNEY (SUp. Ct. I.D. No.)
ADDRESS
PHONE
his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local R, egistrar. The original certificate will be forwarded to the State Vital Records Office for permanent 'filing.
WARNING: it is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
P 9825678
No.
bate"
mos 143 Rev ~e? COMMONWEALTH OF PENNSYLVANIA ° DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
NAME OF DECEDENT (FiITa, Middle. Last) SEX SOCIAL SECURITY NUMBER
~IT I~anuar~ 23~ 2004
K 1. Marie A. Klink 2. Fomale 3. 163- 05
AGE (Las1 Balr~ay) UNDER I YEAR UNDER 1 DAY I DATE OF BIRTH I BIRTHPLACE (City ~
Mon~l~ I Days : Hou~ MblUIe~ I (Morah. Dey, Year) I S~te°tF°f~gnC°ur~)
,,. Dauphin ~.Low~r Swatara I'"- The Middletown Home [~,,,~m.~Rm .... I'"' white
Widowed
325 Wesley Drl~ J
,s. MechanlcsD~g, PA //UDD I~)
INFORMANTS~ME/0a. Fra~lin~Y~)T. Kli~, Jr. ~.404 D Che~e Drive ~i~, PA 17247
~,~' ~ ~ Uh~,.Jan~ 25 2004 ~ollinqer gr~to~ · ~t.Holly Sprinqs, PA
, SiGNAT~ FUll__SEE OR ~ER~ ACTING AS S~H [ LmENSE U ~E AND~E~ ~ F~ILI~
~ ~ATH? A~n ~ p~ Inves~ ~ M -~ ~ ~
Yes ~ NO ~ Yes ~ NoD Sum~ ~ c~d~ ~ ~EOFINJURY AI~ I~ S~l~.~ IL~TI~{~.O~~n.smte)
....................................................................................................................................... 32. ~U/ ~'~'
TYPE/PRINT
PERMANENT
BLACK INK
OF
MARIE A. KLINK
I, MARIE A. ](LINK, of Camp Hill, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and
understanding, do make, publish and declare this my Last Will and
Testament, hereby revoking and making void any and all former
Wills by me at any time heretofore made.
1.
I direct the payment of all my just debts and funeral
expenses as soon after my decease as the same can conveniently be
done.
2.
I direct that there shall be paid out of my residuary estate
all estate, inheritance and like taxes together with any interest
or penalty thereon imposed by the Government of the United States,
or any state or territory thereof, or by any foreign government or
political subdivision thereof, in respect to all property required
to be included in my gross estate for estate, inheritance or like
tax purposes by any of such governments, whether the property
passes under this will or otherwise.
3.
I give, devise and bequeath my entire estate, real, personal
- 1 -
or mixed, of whatsoever nature and wheresoever situate, in equal
shares to my nine grandchildren, viz: FRANKLIN T. KLINK III, PAUL
D. KLINK, RUTH L. ROMAKO, ANDREW C. KLINK, RICHARD A. WALKER,
DAVID M. WALKER, JAMES F. WALKER, THOMAS A. WAT.KERand ROBERT C.
WALKER. In the event a legatee predeceases me, his or her share
shall lapse and fall into the residue of the estate for the
benefit of the residuary legatees who survive me.
4.
Lastly, I nominate, constitute and appoint my son, FRANKLIN
T. KLINK, JR. to be the Executor of this my Last Will and
Testament, and in the event he is unwilling or unable for any
reason to act as such, I nominate, constitute and appoint my
grandson, FRANKLIN T. KLINK III, to be Executor in his place and
stead. I further direct that no bond or other security be
required of my personal representative to guarantee faithful
performance of his duties.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
14th day of November, 1994.
Marie A. Klink
Signed, sealed, published and declared by the above-named
MARIE A. ](LINK as and for her Last Will and Testament, in the
presence of us who have subscribed our names hereto as witnesses,
at her request, in her prese~a~d in t_h~resence of each other.
CONMONWEALTH OF P]~ISYLVAN'I'A )
COUNTY OF CUl~~ )
SS
I, FflLRIE A. K~INK, the testatrix whose name is signed to the
attached or foregoing instrument, having been duly qualified
according to law, do hereby acknowledge that I signed and executed
the same instrument as my Last Will and Testament; that I signed
it willingly, and that I signed it as my free and voluntary act
and deed, for the purposes therein expressed.
Sworn and subscribe~ to
before me this /~/~
day of November, 1994.
Sworn and subscrib~ to
before me this ~
day of November, 1994.
COMMONWEALTH OF PENNSYLVANIA )
· SS
COUNTY OF CUMBERLAND )
We, the undersigned, Je,~ ~. ~2~ and J,
,
the witnesses whose names are signed to the attached or foregoing
instrument, being duly qualified according to law, depose and say
that we were present and saw the testatrix, MARIE A. KLINK, sign
and execute the instrument as her Last Will and Testament; that
the said testatrix executed it as her free and voluntary act for
the purposes therein expressed; that each of us, in the hearing
and sight of the testatrix, signed the Will as witnesses; and
that, to the best of our knowledge, the testatrix was, at the
time, eighteen (18) or more years of age, of sound mind, and under
no constraint, duress or undue influe~~ -
- 1 -
)]NIT)I 'V RIRV~
REVdE00 EX (6-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
OFFICIAL USE ONLY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
~&l-~ K - ,/I~A ~.. t~¢
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
2..3- oq
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND ~IDDLE INITIAL)
FILE NUMBER
~]1. Original Return
E~4. Limited Estate
E~6. Decedent Died Testate (Attach copy of Will)
E~9. Litigation Proceeds Received
FIRM NAME (IfApplicable)
TELEPHONE NUMBER
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Prope~ (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
[~ Separate Billing Requested
7..nter-Wvos Tra.sfers & Misce,aneous Non-Probate Prope
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Modgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12..Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to t~x has not I~een
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(8)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2) x .0. (15)
16. Amount of Line 14 taxable at lineal rate - x .0 I,J..~' (16)
17. Amount of Line 14 taxable at sibling rate x .12 (17)
18. Amount of Line 14 taxable at collateral rate ~ ~j O ~ ~ ~ x .15 (18)
19. Tax Due (19)
>>BE SURE TO ANSWER ALL QUESTIONS ON RE~RSE SIDE AND RECHECK MATH < < :; ::' ~; ~";:
NAME F &,ANK'c '"rt.
THIS SECTION MUST BE COMPLETED, ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE:DIRECTED TO:: !~
[~3. Remainder Return (date of death prior to 12-13-82)
---]5. Federal Estate Tax Return Required
_8. Total Number of Safe Deposit Boxes
F'I 11. Election to tax under Sec. 9113(A) (Attach Sch O)
E~2. Supplemental Return
E~] 4a. Future Interest Compromise (date of death after 12-12-82)
[~7. Decedent Maintained a Living Trust (Attach copy of Trust)
r-~10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
-. SOCIAL SECURITY NUMBER
SOCIAL SECURITY NUMBER
COUNTY, CODE YEAR_ ', NUMBER
Decedent's Complete Address:
STREETADDRESS ,3 ~.,,.~ ~ E5 1. ~%.~
Tax Paym~ .e~n.~s .and Credits;.,
1. Tax Dt]e ('P~g~ 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
STATE
Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits ( A + B + C (2)
Total Interest/Penalty ( D + E
If Line 2 is greater than Line 1 + Line 3, enfer the difference, This is the OVERPAYMENT,
Check box on Page 1 Line 20 to request a refund
(3) ~-~
(4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE,
' ' A. Ente`r the interest on,the tax due., v ' · ; '"' ', · , ', ·
B. Enter the total of L ne 5 +.5& Thi~ is the BALANCE DU~E/.
Make Check Payable to: REGISTER OF WILLS, AGENT,., ,,.
(5) ¢
(5A) .... ,, , ,,
(5B) Iq
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; .......................................................................................... [] []
b. retain the dght to designate who shall use the property transferred or its income; ............................................ [] []
c. retain a reversionary interest; or ................................ ~. ......... : .............................................................................. [] []
d. receive the promise for life of either payments, benefiis or care? ...................................................................... [] []
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. [] []
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. [] []
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .............................. . .......................................................................................... []
IF THE ANSWER TO ANy OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE $ AND FILE IT
AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ~,~'~ ~ ~ .,,,/'
ADDRESS
SIGNATURE OF PREPARER OTHER THAN REPRE~EN~'ATIVE ' '
DATE
'/Izo
DATE
ADDRESS
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. {}9116 (a) (1.1) (i)].
For dates of death on or after'January 1', 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. {}9116 (a) (1.1) (ii)].
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the. o.nly beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 RS'. {}9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. {}9116(1.2) [72 P.S. {}9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. {}9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
~-V-IEO3 EX * (1-~7) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
FILE NUMBER
21- o~(-oo?e
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
~'FE 3'r3:) /z-
,.~',5-'O~ OO o
TOTAL (Also enter on line 2, Recapitulation)
(if more space is needed, insert additional sheets of the same size)
ESTATE OF MARIE A KLINK
FRANKLIN T KLINK JR EXEC
P O BOX 128
COTTAGE 404D CHESAPEAKE DRIVE
QUINCY PA 17247-0128
PETER (PETE) WALTERS
35 EAST MAIN STREET
PO BOX 585
WAYNESBORO PA 17268
717-762-0911
Value Summary (Held at Edward Jones)
Value on Jan 30 $46,125.10
Value on Jan I --
Value one year ago --
Summary of Your Assets
Held at Edward Jones
Value on Value on Change
Jan 30 Jan I in value
Cash & money market $0.10 -- $0.10
Bonds I" 46,~ 25~0~. -- 46,125.00
Total at Edward Jones \ $46,125.10 ~ -- $46,125.10
/
Your Assets at Edward Jones
Cash and money market funds 7-day 7-day Current
current yield oompoundad yield value
Cash $0.10
Total sash and money market funds $0.10
Bonds
Government and agenoy securities
Interest
Rating Maturity value Maturity d~te rate
Aaa $50,000 12/15/2027 5.250%
FEDERAL HOME LOAN MORTGAGE
CORP MEDIUM TERM NOTE
DTD 12/27/2002
CALLABLE 12/15/2007 @ 100.00
Current
value
$48,125.00
Amount
invastad
Amount Your yield
withdrawn to maturity
$50,000.00
Total govamment and sgeney $50,000 $46,125.00 $50,000.00 --
securities
Total bonds $50,000.00 $46,125.00 $50,000.00 --
Total estimated asset value $46,125.10
(E;tete annn. nt~
REV.'rS08 EX * (1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Include the proceeds of litigation and the date the proceeds were received by the estate, All properLy jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1,
tlA~NE$~oP..u PA ~lccr*
Acoc Il,. o[. qq
TOTAL (Also enter on line 5, Recapitulation)
(if more space is needed, insert additional sheets of the same size)
P.O. Box 778
Chambersburg, PA 17201-0778
717-263-4444
~:~, ~ :;. ~:::~.
OFFICE LOCATIONS:
800 Wayne Avenue 247 Overcash Avenue
Chambersburg, PA Chambersburg, PA
140 S. Federal Street 10933 Buchanan Trail E.
ww~.patriotfcu.org
COPY
,D~.oooo~7
Cashier's Check
PNC Bank, National Association
Southcentral PA
60-1273/313
Pay to the ,
Order ofFC TQTF 'F h!~.iPfF' ~ ,:"l , .'-..!?' I $ !':''l ';:,:::,t "i,::i
T:l 0 gF ~CC011HT ::5 i 401. 7~,545'
REMI~ER
MEMBERS 1"
FEDERAL £REDI? UN~ON
P.O. Box 40
FORM 103755-0300
C' ~-:s~iT.: 0 04. ?
~3 Ud
,-~c: 0
Q~ s_
C_~ L~'~ ..0
· ~- U-
C~ C~ L--
TOTAL CASH
Check
Check
$
PNCBAN(
N
B
PAYMENTS:
Loan No,__
Loan No.
Loan No,__
PSL Loan __
S~udent Loan
Key Loan
VISA Payment
Total Amount
(Dash Returned
'E'
MEMBERS Ist
FEDERAL CREDIT UNION
st
Mechanicsburg, PA 1705.5
www.memberslst.org ofAccount I ]60679 10]-01-04 /01-31-04 I] of 2 ~
Main Switchboard: (717) 697-1101 or (800) 283-2328
Ca11-24: (717) 607-4372 or (800) 283-4372
TDD: (717) 607-5312 or (800) 283-2328 ext. 5312
T®leBranch: (717) 795-6049 or (800) 237-7288
IT ALL ADDS UP AFTER AWHILE.
CONTACT OUR FNIC INVESTMENT
PROFESSIONALS TODAY.
MARIE A KLINK
C/O FRANKLIN T KLINK JR
404 D CHESAPEAKE DR
qUINCY PA 17247
631
SUFFIX=O0 SAVINGS ' 51.70
31270L SHARE DIVIDEND
312704 SHARE WITHDRAWAL ~-51'04).74 51.74.00
Y-T-D DIVIDENDS: .04
TRUTH IN SAVINGS INFORMATION
AFiNUAL PERCENTAGE YIELD / 1.00~
AENUAL PERCENTAGE YIELD EARNED/ 1.09~
....... I ....
SUFFIX:05 INVESTMENT SVGS//~A 1~816.8~
012704 SHARE DIVIDEND 10.33 13827.16
012704 SHARE WITHDRAWAL ~-13827.16 .00
Y-T-D DIVIDENDS: 10.33
TRUTH IN SAVINGS INFORMATION
ANNUAL PERCENTAGE YIELD / . O~
ANNUAL PERCENTAGE YIELD EARNED/ 1.05~
SUFFIX:Il CHECKING
BEGINNING BALANCE 501.69
DEPOSITS .00
DRAFTS .00 TOTAL NUMBER DRAFTS CLEARED 0
DEBITS/FEES 501.69
MAINT/SERVICE CHGS .00 YOUR AVG DAILY BALANCE WAS 420.77
ENDING BALANCE .00 YOUR LOW MONTH BALANCE WAS .00
012704 SHARE WITHDRAWAL '~..-~01.69' .00
Y-T-D DIVIDENDS= .00
TRUTH IN SAVINGS INFORMATION
ANNUAL PERCENTAGE YIELD / .25~
SUFFIX:44 5 YEAR CERTIFICATE '*-~'--- 105767.74
!01270L CERTIFICATE DIVIDEND 350~34 106118.08
01270L CERTIFICATE PAYOFF -106118.08' .00
i!iiiiiiiii!!!!!!! i!i i i i!?i?iilii!!!!NOTICEii!!iSEE!REVEiRSESIDE!iFOR!ilMPOR~ANT!NFORMAT[ON~ . ! . i .. .....
REV-1510 EX * ,~1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY % OF
ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE
ATDACH A COPY OF THE DEED FOR REAL ESTATE.
NUMBER VALUE OF ASSET INTEREST CFA~CA~LE)
t 39 33 9
TOTAL (Also enter on line 7, R~apitulation) $
(If more space is needed, insed additional sheets of the same size)
PLEASE RETAIN THIS VOUCHER FOR YOUR RECORDS
1/27/2oo4
137265340
$65,134.76
FRANKLIN If_LINK
Wau
PO BOX 1711 · HARRISBURG, PENNSYLVANIA 17105-1711
235 N. SECOND STREET · HARRISBURG, PENNSYLVANIA 17101 · 717/236-4041
PLEASE RETAIN THIS VOUCHER FOR YOUR RECORDS
1127/2004
137265339
$30,047.29
NK
PO BOX 1711 ,, HARRISBURG, PENNSYLVANIA 17105-1711
235 N. SECOND STREET · HARRISBURG, PENNSYLVANIA 17101 · 717/236-4041
REV-1'511 EX+ (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
5.
6.
7.
FUNERAL EXPENSES:
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State__Zip
Year(s) Commission Paid:
Attorney Fees
Family Exemption: (If dec'dent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
Probate Fees
Accountant's Fees
Tax Return Preparer's Fees
State__Zip
~ 31C,.. '°
TOTAL (Also enter on line 9, Recapitulation) $ ~, ~ I~ ~ . '"'
(If more space is needed, insert additional sheets of the same size)
Ma ezzi Funeral Home
8 Market Plaza Way, Mechanicsburg, PA 17055 (717)697-4696
STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED
Charg.e.s ar~ pnly for those item~ that. ypu selected or that are required. If we are required by law or by a cemetery or a crematory to use an items
~e will e. xplaln the reasons in writing he,ow. Y ,
llVOU selected a funeral that may. require embalming, such as a funeral with viewing, you may haveto pay for embalming. You do not have to p. ay for em aiming you
didnot approve if you selecte[I arrangements suc'~ as a direct cremation or immediate burial. If we charged for embalming, we will explain why l~elow.
For the Service of: Marie A. Klink Date of Death January 23, 2004
Charge to: Franklin T. Klink 404 D Chesapeake Drive Quincy PA
Name Address City State
A. CHARGE FOR SERVICES SELECTED:
1. PROFESSIONAL SERVICES
Services of Funeral Director/Staff ..........
Embalming ............................
Other preparation of body
Other Preparation of Body
SUB-TOTAL OF PROFESSIONAL SERVICES .......... A1 $
2. FACILITIES AND SERVICES
Use of facilities and services for
Viewing (Visitation/Wake) ................ ~..
Use of facilities and services for
Funeral Ceremony ..................... $..
Use of facilities and services for
Memodal Service ...................... $..
Use of equipment and services for
Graveside Service ...................... ~..
Other use of facilities
SUB-TOTAL OF FACILITIES/EQUIPMENT ............ A2 $
3. AUTOMOTIVE EQUIPMENT
Vehicle to transfer remains to Funeral
Local ...............................
Hearse (Casket Coach)
Local ...............................
Limousine
Local ................................
Family Car
Local ................................
Flower car or floral disposition
Local ................................
Lead car/Clergy
Local ...............................
Car for pallbearers
Local ................................
Out of town transportation ................
SUB-TOTAL OF AUTOMOTIVE EQUIPMENT ........... A3 $
TOTAL OF PROFESSIONAL SERVICES,
FACILITIES AND AUTOMOTIVE
EQUIPMENT .................................... A $
B. CHARGES FOR MERCHANDISE
Casket .............................. $
(Description).
Outer Receptacle ...................... $
(Description).
Outer burial container ................... $
(Description).
Acknowledgement cards ................. $.
Register Book(s) ....................... $
Memorial folders ...................... ,$.
Prayer cards ......................... $.
Temporary grave marker ................ .$.
Burial clothing ........................ .$.
Other Clothing
Underclothing $
Cross/Crucifix $
Cremation Urn ..................... $
(Description)_
$
$
$
TOTAL MERCHANDISE SELECTED ........... B $
SPECIAL CHARGES
Forwarding of remains to
(I-uneral Home)
Receiving of remains from
(I-uneral Home)
Immediate Burial ................... $
Direct Cremation ................... $ 1395.00
$
SUB-TOTAL OF SPECIAL CHARGES .......... C $
CASH ADVANCED:
Opening Grave .................... $
Cemetery Equipment, ............... $
Lot and Deed ...................... $
Newspaper Notices - Local ........... $
Newspaper Notices - Out-of-town ...... $ 298.10
Telephone & Telegrams ............. $
Air[are $
Clergy/Mass Offering ............... $
Organist ......................... $
Certified Copies of the Death Certificate .$ 40.00
Military Honor Guard ................ $
Flowers .......................... $
Vault Service Charge ............... $
$
$
$
$
$
$
SUB-TOTAL OF ADVANCES .................. D $
sp e cl3~3rge you~or our ~.erviqes in obtaining:
ectTy casn aovance aems).
none
1395.00
338.10
SUMMARY OF CHARGES:
A. Professional Services, Facilities and
Equipment and Automotive
Equipment ....................... $.
B. Merchandise ...................... $
C. Special Charges ................... $
D. Cash Advances ................... $
1395.00
338.10
TOTAL OF ALL SELECTIONS ................. $ 1733.10
PAID AT TIME OF OR PRIOR TO
ARRANGEMENTS ........................... $ 0.00
BALANCE DUE ............................. $ 1733.10
REASON FOR EMBALMING
Family/Public viewing after 24 hours
If any law, cemetery or crematory requirements have required the purchase of
any of the items lis[ed above the'law or requirement is explained below.
Outer Burial Container Required by Cemet
I agree that 1 have examined the terms of goods and services selected above and found them to be correct and accoramg to the arrangements I nave requestea.
acknowledge receipt of a copy of this Statement of Funeral Goods and Services Selected. I represent that I have sufficient funds available for pay. ment of the cash
price for the goods and servmes selected. I also agree to make payment of $ 1733.1/0thin d~s. I agree to be jointly and severally liable with anyone
~ho ~i, gns, b. el%w:,.A late charge o.f .... .!o/~,.mount!n._g to 12%3.1~r year will be applied to the unpaid balance beginning 30ays
om me aate otmm agreement. ~ wm mso pay to me euneral Director all reasonable costs paid by the Funeral Director to collect amounts I owe under this agreement.
Those costs may include attorney's fees, court costs and other costs. Any additional services or merchandise ordered or requested after the date of this agreement
will be con. si~ed part of this agreement and the cost thereof will be reflected on the final bill or statement.
(Seal) ~r x ~,nO,*cV' Z,~.
(Seal) (Purchaser) (/~,r~~e~or)
(Purchaser)
RECEIPT FOR PAYMENT
Cumberland_County - Register Of Wills
Hanover and Hiqh Street
Carlisle, PA I7013
Receipt Date
Receipt Time
Receipt No.
1/27/2004
12:15:34
1035389
KLINK MARIE A
File Number
Remarks
2004-00078
FRANKLIN T KLINK JR
JA
Transaction Description
PETITION FOR PROBA
EXTRA PAGES
SHORT CERTIFICATE
JCP FEE
Check# 2944
Total Received .........
Distribution Of Receipt ........................
Payment Amount Payee Name
270.00
6.00
30.00
10.00
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
BUREAU OF RECEIPTS & CNTR M.D
16.00
16 O0
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
Include unreimbursed medical expenses.
FILE NUMBER
2,1- c:,~-
ITEM
NUMBER DESCRIPTION AMOUNT
TOTAL (Also enter on line 10, Recapitulation)
9.8,0
(If more space is needed, insert additional sheets of the same size)
** TAXPAYER COPY **
4882
r ~YABLE
TO:
DESC.
TAXES
DUE
AND
PAYABLE
FROM:
BONNIE K. MILLER, TREASURER
1993 HUMMEL AVENUE
CAMP HILL, PA 1701t-5938
JOB TITLE
FULLY RETIRED
CTL 13 10991
SSN 163-05-8539
KL. INK, MARIE A.
325 WESLEY DR. #119
MECHANICSBURG PA
17055
TAX
COL,. MON TUES & THURS 9AM-4PM OR BY
OFFICE '
APPT; 4/29 9AM-BPM; 4/30 9AM-4PM
HOU.S: BONNIE MILLER@LOWER-ALLEN. pA. US
CLSD HTDYS 717-975-7575 EXT 1701
:-NCLOSE SELF ADDRESSED STAMPED ENVELOPE IF RECEIPT IS DESIRED
BILL DATE 3/01/2004 BILL NO 4882
2004 PERSONAL TAX NOTICE
COUNTY OF CUMBERLAND -- -
TOWNSHIP OF LOWER ALLEN --
UNPAID TAXES SUBMITTED TO DELINQUENT COLL 12/31/04
VALUE 0
CNTY P/C
HUN P/C
5.ooooo 4. 5.00 5.50
5.ooooo 4.90 5. O0 5.50
I 9.80 10.00 11.00
/lC 2.0% :1.0.0% DISCOUNT FACE PENALTY
YP~C/ 2.0% 10.0% 3/01/2004 5/01/2004 AFTER
TO TO
4/30/2004 6/30/2004 6/30/2004
DEADLINE T~_~PPEAL OR CI-IANGE JOB TITLE IS 90 DAYS FROM .BILL DATE
240'6365 0R'697-0371 EXT 6365 OR 532~7286 EXT 6365
PRIVATE
DATE DESCRIPTION OR CODE
~ AMOUNT ACCOUNT
CR BALANCE
PAY LAST
THE MIDDLETOWN HOME AMOUNT IN
999 WEST HARRISBURG PIKE THIS COLUMN
MIDDLETOWN, PA. ~7057
PHONE (717) 944-3351
01/02/04
Ol/O5/O4
01/05/04
01/13/04
01/16/04
iTY FOR
6211987
6211988
6210779
6212398
MARIE
Pymt- - 00100437
FUROSEMIDE 10MG/M
FUROSEMIDE 40MG T
DILTIAZEM HCL 120
FUROSEMIDE 40MG T
114.19
3.74
4.44
31.97
5.41
114.1:
.00 3.7,
.00 4.4,
.00 31.9'
.00 5.4~
L
LEGEND
+ = '114.19
45.5~
~ ~"~/. ~ ~2c¥~..;~'l~f'j~( Page 2of 12 ~'~<L~
Yerl; orl ~ ~, 717 796-2184-816 01Y
February 9, 2004
This information is required by the Public Utility Commission. "Basic"
service includes the line charge, local calling and TOUCH TONE service
(if applicable). "Non-Basic" service includes optional services, other
than Touch Tone, such as Maintenance agreement for inside wire and
Guardian and does not include toll services.
Non-payment of any past due basic charges could result in suspension
of your local service after you receive a separate written statement.
BASIC
TOLL
NON- BAS IC
TOTALS
Past Due Current Totals
Ba lances Charges
$12.89 $ - 8.89 $4.00
$. O0 $. 00' $. O0
$. O0 $. 00' $. O0
$12.89 $ -8.89 $4.00
The following pages provide additional details.
* (Includes Verizon and other service provider(s) charges.)
REV-1513 EX+ (9-00~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
KLI~ ~ 4~Z t-~ 2,1-o,~-
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
FILE NUMBER
I
1.
I!
1.
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
Franklin Klink III, 168 East Side Drive, Greencastle, PA 17225
Paul Klink, 6605 Bellview Drive, Columbia, MD 21046
Ruth Romako, 323 15th Street, New Cumberland, PA 17070
Andrew Klink, 2332 North Fifteenth Avenue, Phoenix, AZ 8525
Richard Walker, 1827 Johen Drive, Murfreesboro, TN 37128
David Walker, 196 Windrift Lane, Rochester, MI, 48307
James Walker, 21837 Little Brook Way, Strongsville, OH 44136
Thomas Walker, 334 More Drive, Boulder Creek, CA 95006
Robert Walker, 190 Harrisburg Street, Bay Shore, NY 11706
EAt. It
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
Register of Wills of CUMBERLAND County, Pennsylvania
Certificate of Grant of Letters
WHEREAS, on the 27th
dated November 14th 1994
No. 2004-00078
PA No. 21-04-0078
ESTATE OF KLINK MARIE A
Late of
LOWER ALLEN TOWNSHIP
~UM~./--LSI~ ~U~'£'Z,
Deceased
Social Security No. 163-05-8539
day of January
2004 an instrument
was admitted to probate as the last will of KLINK MARIE
(nAS'Z, ~'i~S'i',
late of LOWER ALLEN TOWNSHIP , CUMBERLAND County, who died on the
23rd day of January 2004 and,
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, GLENDA FARNER STRASBAUGH , Register of Wills in and for
the County of CUMBERLAND in the Commonwealth of Pennsylvania, hereby certify
that I have this day granted Letters TESTAMENTARY
to KLINK FRANKLIN T JR
who has duly qualified as Executor(rix)
and has agreed to administer the estate according to law, all of which fully
appears of record in my Office at CUMBERLAND COUNTY COURT HOUSE,
CARLISLE, PENNSYLVANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my Office the 27th day of January 2004.
**NOTE** ALL NAMES ABOVE APPEAR (LAST, FIRST, MIDDLE)
OF . .
MARIE A. KLINK ..
I, MARIE A. KLINK, of Camp Hill, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and
understanding, do make, publish and declare this my Last Will and
Testament, hereby revoking and making void any and all former
Wills by me at any time heretofore made.
1.
I direct the Payment of all my just debts and funeral
expenses as soon after my decease as the same can conveniently be
done.
2.
I direct that there shall be paid out of my residuary estate
all estate, inheritance and like taxes together with any interest
or penalty thereon imposed by the Government of the United States,
or any state or territory thereof, or by any foreign government or
political subdivision thereof, in respect to all property required
to be included in my gross estate for estate, inheritance or like
tax purposes by any of such governments, whether the property
passes under this will or otherwise.
3.
I give, devise and bequeath my entire estate, real, personal
- 1 -
or mixed, of whatsoever nature and wheresoever situate, in equal
shares to my nine grandchildren, viz: FRANKLIN T. KLI~ III, PAUL
D. KLINK, RUTH L. ROMAKO, ANDREW C. KLINK, RICHARD A. wrAJ~KER,
DAVID M. WALKER, JAMES F. WALKER, THOMAS A. WALKER and R~BER~
WALKER. In the event a legatee predeceases me, his or her share
shall lapse and fall into the residue of the estate for'
benefit of the residuary legatees who survive me.
Lastly, I nominate, constitute and appoint my son~ F~ANKLIN
T. KLINK, JR. to be the Executor of this my Last Will
Testament, and in the event he is unwilling or unable f.ur amy
reason to act as such, I nominate, constitute and appoint mY
grandson, FRANKLIN T. KLINK III, to be Executor in his ~]mce and
stead. I further direct that no bond or other securit~ be
required of my personal representative to guarantee
performance of his duties.
IN WITNESS WHEREOF, I have hereunto set my hand a~ seal this
14th day of November, 1994.
Marie A. Klink
Signed, sealed, published and declared by the abov~-.na9sd
MARIE A. KLINK as and for her Last Will and Testament, in
presence of us who have subscribed our names hereto as
o~her.
at her request, in her prese~ an
COMMONWEALTH OF PENNSYLVAN'r& ~
COUNTY OF CUMBERLAND )
SS
I, MARIE A. KLINK, the testatrix whose name is signed to the
attached or foregoing instrument, having been duly qualified
according to law, do hereby acknowledge that I signed and executed
the same instrument as my Last Will and Testament; that I signed
it willingly, and that I signed it as my free and voluntary act
and deed, for the purposes therein expressed.
Sworn and subscribe~d to
before me this
day of November, 1994.
COMMONWEALTH OF PENNSYLVANIA )
: SS
COUNTY OF CUMBERLAND )
We, the undersigned, J~,- ~. ~WF~/
Sworn and subscrib~ to
before me this ~
day of November, 1994.
,
the witnesses whose names are signed to the attached or foregoing
instrument, being duly qualified according to law, depose and say
that we were present and saw the testatrix, MARIE A. KLINK, sign
and execute the instrument as her Last Will and Testament; that
the said testatrix executed it as her free and voluntary act for
the purposes therein expressed; that each of us, in the hearing
and sight of the testatrix, signed the Will as witnesses; and
that, to the best of our knowledge, the testatrix was, at the
time, eighteen (18) or more years of age, of sound mind, and under
no constraint, duress or undue influe~.. ~ . ~..~-~ ~-~-r--*-
- 1 -
IMPORTANT NOTICE
NOTICE OF ESTATE ADMINISTRATION
THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE
ANY MONEY OR PROPERTY FROM TI-HS ESTATE OR OTHERWISE
Whether you will receive any moncy or property will be determined
wholly or partly by decedent's will. If the decedent
died without a will, whether you will receive any money or property
will be determined by intestacy laws of Pennsylvania
BEFORE TH~ RF_~ISTER OF WILLS, COUNTY OF CUMBERL~D, CARLISLE, PA
In re Estnte of Marie A Klink, 325 Wesley Drive, room 200, Mechanicsbmg, PA 17055,
decensed January 23, 2004.
TO: Franklin Klink IH, 168 East Side Drive, Greencastle, PA 17225
Paul Klinl~ 6605 Bellview Drive, Columbin, IvlD 21046
Ruth Romnko, 323 15th Slreet, New Cumberland, PA 17070
Andrew Kllnk, 2332 North Fifl~enth Avenue, Phoenix, AZ 85251
Richnrd Walker, 1827 Joben Drive, Mm'fi'eeshoro, TN 37128
David Walker, 196 Windrift Lane, Rochester, MI, 48307
James Wnlker, 21837 Little Brook Way, Strongsville, OH 44136
Thomas Walker, 334 More Drive, Boulder Creek, CA 95006
~.~Wal?~._er~._, 190 Harrisburg Street, Bay Shore, NY 11706
Plense tnke notice of the death of decedent and the grnnt of letters to the personnl rep~-
santative named below:
Fnmklln T. Klink Jr. 1440 SE San Souci Lane, Port Saim Lucic, FL 34952, ph. 772-398-4794
(after April 15, 2004) 404 D Chesapeake Drivc, Quincy, PA 17247, ph 717-749-7492
The Decedent Marie A Klink died on thc 23 day of January, 2004 at Dauphin County,
Middletown, Penasylvania.
,
The Decedent died testnte (with a Will) ~'-~- - "'
The will has been filed with the Office of the Register of Wills of Cumberland County, 1 Com't-
; 0. house Squn~, Cnrlisle, PA 17013. Phone No. 717-240-6345.
A copy of the Will or Petition may be obtained by contacting the Register of Wills and paying
the charges for duplication.
Date: March 1, 2004
Signature:
Address:
after 4/15/04
Capacity:
Franklin T. Klink Jr. ....
1440 SE San Souci Lane, Port St. Lucie FL
phone:772-398-4794
404D Chesapeake Dr. Quincy, PA 17247
phone: 717-749-7492
Personal Representative
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD 003849
KLINK FRANKLIN T JR
404D CHESAPEAKE DR
QUINCY, PA 17247
fold
ESTATE INFORMATION: SSN: 1 63-05-8539
FILE NUMBER: 2104-0078
DECEDENT NAME: KLINK MARIE A
DATE'OF PAYMENT: 04/21/2004
POSTMARK DATE: 00/00/0000
COUNTY: CUM BERLAN D
DATE OF DEATH: 01/23/2004
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $19,567.37
REMARKS:
SEAL
CHECK# 111
TOTAL AMOUNT PAID:
$19,567.37
INITIALS' JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
Name of Decedent:
Date of Death:
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Will No. '~Z O O ~ 6 ~ C '-] '~ Admin. No. ~ 1' ~ ~ ~0'7 e~
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on :
Name Address
Notice has now been given to all persons entitled thereto under Rule 5.6(a) e~c~t
Date:
Signature
~)31 kO.
Capacity: _
Telephone
Personal Representative
__.Counsel for personal representative
BUREAU OF INDIVIDUAL TAXES
IHHERTTAHCE TAX DIVISIOH
DEPT. 280601
HARRTSBURG, PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOgANCE OR DZSALLOgANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
RE¥-1~47 EX AFP [n1-03)
FRANKLIN T KLINK JR
404D CHESAPEAKE DR
PO BOX 01Z8
QUINCY PA 17247
BATE 06-08-2004
ESTATE OF KLINK
BATE OF DEATH 01-25-2004
FILE NUHBER 21 04-0078
COUNTY CUMBERLAND
ACN 101
Amoun'l: Rami*~:ad
MARIE A
HAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAHD CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
iDlY- i=-6 T - - .................
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF KLINK MARIE AFZLE NO. 21 04-0078 ACN 101 BATE 06-08-2004
TAX RETURN gAS: ( ) ACCEPTED AS FILED (X) CHANGED SEE ATTACHED NOTICE
RESERVATION CONCERN/NG FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORTGZNAL RETURN
1. Real Es~a~a (Schedule A) (1)
2. S~ocks and Bonds (Schedule B) (2)
$. Closa1¥ Hald S~ock/Par~narship Zn~aras~ (Schadula C) ($)
~. Hor~gagas/No~as Raceivabla (Schedule D) (~)
5. Cash/Bank Oaposi~s/flisc. Personal Propar~y (Schedule E) ($)
6. Jointly Owned Propar~y (Schedule F) (6)
7. Transfers (Schedula G) (71
B. To~al Assa~s
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funaral Expanses/Adm. Cos~s/N~sc. Expenses (Schedule H) (9)
10. Deb~s/Nor~gaga Liabilities/Liens (Schadula I] (lO)
11. Tolal Deductions
12. Nat Value of Tax Return
.00
46~125.10
.00
.0O
248;608.04
.00
NOTE: To insure proper
cradL~ to your account,
submi~ ~ha upper portion
of ~his fore ~i~h your
~ax payment.
2,049.10
260.14
(11) 2. SOI:) . 24
(12) 587,605.95
19. Princi
TAX CREDITS
PAYHENT
DATE
04-21-2004
15.
14.
NOTE:
ASSESSMENT OF TAX:
15. Amoun~ of Line lQ a~ Spousal rata
16. Amoun~ of Line lq ~axabla a~ Linaal/Class A ra~e
17. A.oun~ of L1na lq a~ Sibling ra~a
18. Amoun~ of Lina lq ~axabla a~ Collateral/Class B ra~a
)al Tax Due
RECEIPT
NUHBER
CD005849
DISCOUNT (+ J
INTEREST/PEN PAID (-)
872.11
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
reflect figures that include the total o.F ALL returns assessed to date.
(15) .00 x O0 = .00
(16) :587,605.95 x 045= 17,442.27
(17) . O0 x 12 = . O0
(18) .00 x 15 = .00
(19)= 17,442.27
AHOUNT PAID
19,567.57
TOTAL TAX CREDIT I
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
Chari*able/Govarnean~al Bequos*s; Non-elected 9115 Trusts (Schedule J) (13) . O0
Na~ Value of Es~a~a Subjac~ ~o Tax (lq) 587,605.95
I~ an assessment was issued previously, lines 1~, 15 and/er 16, 17, 18 and 19 will
20,459.48
2,997.21CR
.00
2,997.21CR
( ZF TOTAL DUE IS LESS THAN $1, NO PAYMENT ZS REgUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE.
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
95~182.05
(8) 589,915.19
RESERVATION:
PURPOSE OF
NOTICE:
PAYMENT:
REFUND (CR):
OBJECT[OHS:
ADMIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before December 1Z, 19Bg -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Coeeonmaalth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such future interest.
To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z5 of ZOO0. (7g P.S.
Section 91q0).
Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side.
--Make check or money order payable to: REGISTER OF NZLLS, AGENT
A refund of a tax credit, which wes not requested on tho Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Xnheritance and Estate Tax" (REV-IS15). Applications are available at the Office
of the Register of Hills, any of the 25 Revenue District Offices, or by calling the special gq-hour
answering service for fores ordering: 1-800-562-2050; services for taxpayers with special hearing and / ar
speaking needs: 1-800-q~7-50ZO (TT only).
Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice oust object within sixty [60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of AppeaIs, Dept. Z810ZI, Harrisburg, PA 171ia-log1, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to tho Orphans' Court.
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individua! Taxes, ATTN: Post Assessment Reviae Unit, Dept. g80601, Harrisburg, PA 171Z8-060!
Phone (717) 787-6SOS. See page S of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-IS01) for an explanation of administratively correctabZe errors.
If any tax due is paid within three (5) calendar months after the decedent's death, a five percent (Si) discount of
the tax paid is allowed.
Tho 1Si tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996j the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of
six (6X3 percent per annum calculated at a daily rate of .00016~. All taxes which became delinquent on and after
January 1, 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through ZOOfi are:
interest Daily Interest Daily Interest
Daily
Year Rate Factor Year Rate Factor Year Rate Factor
~ ZOZ .0005q8 ~'~-8-1991 11Z .000501 ~ 9Z .O00Zq?
1985 162 .000~38 199Z 92 .O00Z~7 ZOO2 6Z .00016~
19Bq i1Z .000501 1993-199q 72 .O0019Z 2005 5Z .000157
1985 15Z .000356 1995-1998 9Z .000Z~? gOOq ~Z .000110
1986 lOX .O0027~ 1999 72 .OOOlgZ
1987 102 .00027~ ZOO0 7Z .00019Z
--Interest is calculated
as folloes:
INTEREST = BALANCE OF TAX UNPAID X NUIIBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen C15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must bm calculated.
~EV-1470 EX (6-88)
INHERITANCE TAX
EXPLANATION
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE OF CHANGES
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG~ PA 17128-0601
FILE NUMBER
DECEDENTS NAME Marie A Klink 2104-0078
ACN
REVIEWED BY Deborah Washington 101
ITEM EXPLANATION OF CHANGES
SCHEDULE NO.
G I Changed tax rate from 15 percent to 4.5 percent since a daughter-in-law is a lineal
beneficial.
ROW Page 1
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280&01
HARRISBURG, PA 17128-0601
FRANKLIN T KLINK JR
404D CHESAPEAKE DR
PO BOX 0128
QUINCY PA 17247
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
[NHERTTANCE TAX
STATEMENT OF ACCOUNT
~*C{":~/:~, ~ DATE 07 - 06 - 2004
:*~ ~?~i-~ E~AT~*fOF KLINK MARIE A
...... : O~i:~F DEATH 01-2~-2004
FILE NUMBER 21 06-0078
JUL 3~c°~TY CU.BERLAaO
UA~l :29
Amount Remitted
Ctt~nbe~'~ar~-a Co~,
MAKE CHECK PAYABLE AND REMIT PAYMENT
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
NOTE: To insure proper credit to your account, submit the upper port/on of this fora w/th your tax payment.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV-1607 EX AFP COl-OS) ~ INHERITANCE TAX STATEMENT OF ACCOUNT ~
ESTATE OF KLINK
MARIE A FILE N0.21 04-0078 ACN 101 DATE 07-06-2004
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSHENT OR RECORD ADJUSTMENT: 06-01-2004
PR[NC[PAL TAX DUE:
17,442.27
PAYMENTS CTAX CREDITS):
PAYMENT
DATE
04-21-2004
06-15-2004
RECEIPT
NUMBER
CD005849
REFUND
IF PAID AFTER THIS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN .1,
NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT"
AMOUNT PAID
DISCOUNT C+)
INTEREST/PEN PAID (-
872.11
.00
19,567.57
2,997.21-
TOTAL TAX CREDIT 17,442.27
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .go
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 12/16/2005
KLINK FRANKLIN T JR
404D CHESAPEAKE DR
QUINCY, PA 17247
RE: Estate of KLINK MARIE A
File Number: 2004-00078
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by:
1/23/2006
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
,~~u~
/" .!
GLENDA FARNER STR~SBAUGH
REGISTER OF WILLS
cc: File
Counsel
Judge
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STATUS REPORTUN'DERRu'LE 6.n
Name of Decedent: !111!:J ~ / f A KL ( t-J {<.
Date of Death: I /2. ~ f () "
(
Estate No.: ;; (j 0 t.{ -- 000 78
.
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following
with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes ~ No 0
2. If the answer is No, state when the personal representative reasonably believeo: th;:tt
the administration will be complete:
3. If the answer to No.1 is Yes, state the follmving:
a. Did the personal representative file a final account with 'the Court?
Yes 0 No 00
b. The separate Orphans' Court No. (if any) for the personal representative's
j account is:
c. Did the personal representative state an account informally to the parties in
interest? Yes 1lS No 0
c. Copies of receipts, releases, joinders and approval of formal or informal
accounts may be filed with the Clerk of the Orphans' Court and may be
attached to this report.
Date: Il~7 / of
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Signature t/
f 'J. I< L,/ f.Jk ~
Name
it 04 j) c: j-J e~.4 ,J ffA J:' 1i
4UiN('1 PA
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Address
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} 72 '--17
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II 7 7'tCJ
Telephone No.
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Capacity: ~ei."s()nal P...epresentati-ve
o CO'LlDsel for personal representative
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